SUMMARY:

• Experienced Senior Business Analyst with over 8 years of proven skills in requirement gathering, interacting with developers, documenting various business processes, coordinating various projects
• Extensive experience working in all stages of system development Life Cycle. Extensive experience leading, facilitating conducting Joint Application Development (JAD) sessions among user community, stake holders and technical management, creating project plans and schedules and managing changes.
• Also, Analysed and synthesized results from Joint Application Development (JAD), proposed alternative tasks and transformed those into Business Requirement Document (BRD).
• Experience in using methodologies such as UML (Unified Modelling Language), OOAD (Object Oriented Analysis and Design) and APM (Agile Project Management).
• Experience in Rational Unified Process (RUP), Rational Requisite Pro, Rational Clear Quest, and Microsoft Project.
• Experience using Rational Rose and MS Visio for business process modelling and designing data flow diagrams (DFD).
• Experience in conducting GAP analysis, User Acceptance Testing (UAT), SWOT analysis, Cost Benefit analysis, ROI Analysis and Requirement Traceability Matrix (RTM)
• Preparing graphical depictions of use cases including State Diagrams, Activity Diagrams, Sequence Diagrams, Use Case Diagrams, Component - Based Diagrams, Collateral Diagrams, including the Business Workflow Chart.
• Very good understanding of Relational Database, Object Oriented Programming, Data Modelling, Data Mapping and Data-warehousing.
• Expertise in writing Requirements, Technical Specs, Test Plans and Test Cases.
• Prepared Functional Specification Documents, AS-IS and TO-BE workflows.
• Strong skills performing data analysis, impact analysis, risks analysis, writing test cases for User Acceptance Testing. Gathered Functional and Data Requirements, analysed workflows and created Use Cases, Requirement Specifications, Report Specifications, Data Requirements, Data Mappings and Data Flow Diagrams.
• Experience in implementation of HIPAA 4010 and HIPAA 5010 changes in the existing claim processing integrated system.
• Experience in Rational Rose & HP Quality Centre
• Experienced working in Medicare and Medicaid projects.
• Knowledgeable for gap analysis in changing old MMIS and Involved in testing new MMIS.
• Excellent knowledge of Health Insurance Portability and Accountability Act (HIPAA) transaction and code set rules such as EDI 837,270,271,276,277,834,835 ERA/EFT.
• Proficient inICD-9-CM and ICD -10-CM coding and claims processing.
• Experienced in all phases of the Software Development Life Cycle (SDLC), Rational unified process (RUP) and SCRUM methodology.
• Managed a Test Director environment for the test team. This includes additions to all forms in the TestDirector application (i.e. Defects, Test Plan, Test Lab and Requirements) and provides server maintenance when needed.
• Broad Knowledge in reviewing Test Procedures, creating Test plans and detailed test plans for UAT, Test scenario, defining Test cases, both System & Integration and executed many test cases Test Data reviewing and maintaining and executing detailed Test scripts for UAT, analyzing bugs, interacting with team members in fixing errors and User Acceptance Testing (UAT) and also assisted in post - Production support. Worked on Black box and White box Testing.
• Experience in Data Mining and analysis
• Thorough knowledge in Requirement analysis, Planning, Scheduling & Tracking projects.
• Worked extensively on B2B applications and B2C applications in transaction processing and E-commerce applications.
• Concrete understanding of Business Requirement gathering, Business Process flow, Business Process Modelling and Analysis, design documentation.
• Work with the development team to provide an environment ready for testers and end-users.
• Facilitated test plan/test case walk-thru's for the Business and Development teams to obtain feedback and/or approval sign-off.

TECHNICAL SKILLS SUMMARY:

Systems/Architectures: Web, VB Client/Server, Main Frame, Windows

Languages: SQL, JAVA, HTML, C++, C

Databases: MS SQL, Oracle, MS Access

Test Tools: Test Director, Quality Center, Quick Test Pro (QTP), Win Runner, HP Quality Center

Other Tools: Visio, Front Office, Rational Rose, Rational Requisite Pro, Software Modeler, Team Test, Doors, Clearcase, Clear quest, Win Runner, Load Runner, Web Sphere, Microsoft Office 2010 ( Project, Word, Excel PowerPoint, Access, Visio)

Standard Skills: HIPAA, SOX, ISO

PROFESSIONAL EXPERIENCE:

Confidential, AL

Sr. Business Analyst

Responsibilities:

• Gathered Business Requirements, analyzed data/workflows, and defined the scope and created requirement specification document followed by design configuration documents, met with client groups to determine User Requirements and Goals, thus converting User Requirements into Business Requirements and User and Technical Requirement Specification
• Facilitated collection of Functional Requirements from system users, and prepared Business Requirement documents
• Experience working in aSDLCenvironment.
• Involved in development of Business and Technical Requirements in preparation of Design and Functional Specifications for Business Needs and Processes.
• Worked closely with Business users to determine the workflow.
• Worked with JIRA 6.1 to key in risk and issues
• Created Test Cases and Test Scripts in HP Quality Center. Created and executes test scenarios for configuration
• Experienced with HIPAA - 4010/5010 standards
• Experienced with EDI files 834,835,270/271, 276/277 file formats
• Analyzed trading partner specifications and created EDI mapping guidelines.
• Experienced working in Medicare and Medicaid projects.
• Knowledgeable for gap analysis in changing old MMIS and Involved in testing new MMIS.
• Hands on experience with the 837 and 835 ANSI X12 transaction understanding loops segments, elements and structure and validating 999s and 835s
• Performed Data Mapping for Core CARC/RARC Mapping
• Involved in Project Management
• Identifies system issues and reports and monitors resolution of those issues
• Create mapping requirements specifications for both inbound and outbound EDI transactions ensure compliance with HIPAA regulations and requirement
• Worked with Six Sigma methodology.
• Work with internal tool to interact with replicated Data Files, how to create custom reports and ad-hoc queries, as well as how to run existing “template”
• Analyze and document business requirements including business rules, quality attributes performance, goals, and external interfaces and constrains.
• Performed walkthroughs of the prototype with end users to better understand user needs.
• Followed a structured approach to organize requirements into logical groupings of essential business processes, business rules, and information needs, and ensured that critical requirements are not missed.
• Followed the UML based methods using MS Visio to create Use Case Diagrams, State Chart Diagrams and Sequence Diagrams
• Used Quality Management System Processes and templates

Technical Environment: Microsoft Office, Windows XP, Toad, SQL, JBo, Business Objects Toad, Visio, Oracle, HTML, XML

Confidential, Michigan, MI

Sr. Business Analyst

Responsibilities:

• Locate the 837 transactions and reports in the file that are in error and validate the data in the transactions. Dealt with the 837, 834 and 835 ANSI X12 transaction understanding loops segments, elements and structure.
• Experience with AGILE Tool and worked with Six Sigma methodology.
• Monitor Medicare Part D PBM contract including, but not limited to, rebate amounts, claim pricing and benefits, formulary coverage/tiering application and contractual performance measures.
• Worked with Six Sigma methodology.
• Worked with JIRA to key in risk and issues
• Provide internal departments with monitoring and audit support of Medicare Part D claims to ensure CMS compliance.
• Experience working in EMR/EHR
• Knowledge of pharmacy data (claims, fees, eligibility, benefits, formulary) and statistical analyses
• Experienced with HIPAA - 4010/5010 standards
• Experienced with EDI files 834,835,270/271, 276/277 file formats
• Analyzed trading partner specifications and created EDI mapping guidelines.
• Experienced working in Medicare and Medicaid projects.
• Knowledgeable for gap analysis in changing old MMIS and Involved in testing new MMIS.
• EDI healthcare experience working with implementation guides, TR3s
• Hands on experience with the 837 and 835 ANSI X12 transaction understanding loops segments, elements and structure and validating 999s and 835s
• Coordinated the setup of new trading partners, including planning, project management, testing, documentation, and implementation. Developed and maintained functional specifications for new / existing applications needed to maintain/enhance EDI processing and address the requirements of new trading partners
• Experience in Business Change Management and Business Process Documentation
• ExcellentAnalytical skills verbal and written communication skills, individuals will be interacting with external trading partners and management.
• Proficient with Microsoft Office

Technical Environment: Microsoft Office( MS Word, MS Excel, MS PowerPoint, MS Visio, MS Access),Rational Requisite, RUP, XML, VB.NET, Oracle, RUP, UML, SQL, Test Director.

Confidential, Saint Petersburg, Florida

Business Systems Analyst

Responsibilities:

• Implemented an integrated RUP solution with complete line of traceability for all the artifacts of web development projects
• Worked with Six Sigma methodology.
• Responsible for designing future state processes forHIPAA 5010 transaction processing EDI’s 837 and 835.
• Worked with JIRA 6.1 to key in risk and issues
• Analyzed HIPAA 5010 related to 837,835, 834. Transactions and performed gap analysis between HIPAA 4010 and 5010.
• KnowledgeofICD-9-CM and ICD -10-CM coding and claims processing.
• Involved in the creation and maintenance of the Workflow plans and artifacts
• Prepared Business Process Models that includes modeling of all the activities of the business from the conceptual to procedural level. Followed top down, leveled technique for building Business Process Models
• Experience with AGILE Tool and methodology
• Serve as subject matter expert with respect to the annual benefit changes and rules associated with the Medicare Part D program
• Knowledge of pharmacy data (claims, fees, eligibility, benefits, formulary) and statistical analyses
• Worked with Six Sigma methodology.
• Conducted SWOT Analysis for better market understanding and fool proof project implementation
• Experience in Business Change Management
• Experience in Business Process Documentation
• Experienced working in Medicare and Medicaid projects.
• Knowledgeable for gap analysis in changing old MMIS and Involved in testing new MMIS.
• Documented Requirement Traceability Matrix(RTM) for requirement elicitation and linkup to deliverables
• Experience with Claims Platforms NASCO
• Worked with the individual sub-project managers to translate these into PRDs (Product Requirement Documents) for the development teams
• Examined, analyzed and model Test plans, Use Case Model cases & Test procedures based on RUP methodology
• Designed and developed Quality Assurance standard and processes to all levels of project team
• Performed Gap analysis for the modules in production, conducted feasibility study and performed impact analysis for proposed enhancements
• Verified the functional aspect as per the Business Process and validated the interfaces with the other systems and data conversion from the existing system
• Experience in Data Mining and analysis.
• Experience with SharePoint Service.
• Used MS Project for various planning and budgeting activities.
• Performed UAT and logged test results according to the test plans using TestDirector
• Wrote clear, concise detailed System Requirements Specification(SRS) documents and user documentation in accordance to guidelines and standards of a level where developers can interpret, design and develop the application with minimum guidance

Technical Environment: Microsoft Office( MS Word, MS Excel, MS PowerPoint, MS Visio, MS Access),Rational Requisite, RUP, XML, VB.NET, Oracle, RUP, UML, SQL, Test Director.

Confidential, Wilmington, California

Business Analyst

Responsibilities:

• Coordinated with the stakeholders and project key personnel to gather functional and non-functional requirements during JAD sessions.
• Studied the existing business process and created AS-IS workflow to illustrate the existing system.
• Recorded requirements in the Requirement Traceability Matrix (RTM) defining each technical requirement in detail from areas like: main hardware, application software, networks, servers, internet and desktop configuration.
• Propose strategies to implement HIPAA 4010 in the new MMIS system & eventually move to HIPAA 5010.
• Experience with AGILE Tool and methodology.
• Responsible for the full HIPAA compliance lifecycle from gap analysis, mapping, implementation and testing for Medicaid Claims.
• Responsible for gap analysis in changing old MMIS and Involved in testing new MMIS. Also, accountable for Medicaid Claims Resolution/Reimbursement for peach state health plan using MMIS.
• Experienced working in Medicare and Medicaid projects.
• Knowledgeable for gap analysis in changing old MMIS and Involved in testing new MMIS.
• Assisting the project manager in creating the business case and project plan.
• Served as a liaison between the internal and external business community (Claims, Billing,, Capitation, Customer service, management, provider management, advanced Healthcare management, provider agreement management) and the project team.
• Actively analyzed current business processes (Claims, Recipient eligibility and enrollment etc.) and worked with management to improve and implement enterprise solutions to ensure compliance
• Experience with Claims Platforms NASCO
• Experience in Rational Rose & HP Quality Centre
• Followed the UML based methods using Rational rose to create Use Cases, Activity Diagram, Sequence Diagram, Collaboration Diagram that include Functional and Non-Functional specifications to hand off to development teams.
• Actively involved in updating internal processes (submit claims, check eligibility), updating data collection and data reporting
• Defects and bug testing by using Rational Clear-Quest, Configuration management and Version control with Clear-Case.

Technical Environment: Microsoft Office(MS Word, MS Excel, MS PowerPoint, MS Visio, MS Access), RUP, MS Project, ANSI X12- EDI UML, Rational Requisite Pro, MS Word, Visio, SQL, MS Excel, Mercury Quality Center.

Confidential, Parsippany, New Jersey

Business Analyst

Responsibilities:

• Propose strategies to implement HIPAA 4010 in the new MMIS system & eventually move to HIPAA 5010.
• Involved in the creation of the Mockups and Use Cases for MACD quotes and Orders using MS Visio.
• Documented business requirements, and communicated these requirements with the development team for design and implementation of business solutions.
• Worked with Business Analysis team to prepare a detailed Business Requirement Document.
• Analyzed Business Requirements to develop Functional and detail Design Specifications of the application.
• Conducted Requirement Gathering Sessions with the stakeholders.
• Interacted with the project team to help define the Business and System Objectives, confirmation of scope, identify constraints and the measures of success for the system to be developed.
• Experience working in Content Management System: CMS
• Conducted the JAD sessions, daily meetings, brainstorming sessions to solve the problems and enhance the workflow.
• Assisted in building a Business analysis process model using Rational Rose and Visio.
• Gathered Functional Requirements from users and the management. Coordinated all the requirements in team based environment.
• Acted as liaison between the senior management and different teams with effective presentations.
• Experience in Rational Rose & HP Quality Centre
• Monitored change requests and documented requirements, integrating them with Use Clear Cases.
• Incorporated stakeholder feedback throughout project lifecycle to ensure project quality and customer satisfaction.
• Did Technical documentation for the project using tools like Visio, Word, etc.
• Used MS Project for managing schedules, resources and collaboration.

Technical Environment: Microsoft Office( MS Word, MS Excel, MS PowerPoint, MS Visio, MS Access),RUP, MS Project, Toad, Visio, Oracle, HTML, Test Director, Rational Rose, UML 2.0, MS Project